Bill defines 'medically necessary' abortions

Bill pertains to which abortions Alaska must pay for under state Medicaid program

JUNEAU — A bill introduced Monday in the Alaska Senate would define “medically necessary” abortions as those needed to avoid serious risk to a woman’s life or physical health.

The measure, from Senate Majority Leader John Coghill, pertains to which abortions Alaska must pay for under the state Medicaid program. The bill calls for the Department of Health and Social Services to not pay for abortion services under the program unless those abortions are medically necessary or the pregnancy was the result of rape or incest and the rape or incest was “promptly reported” to law enforcement or public health authorities. Payment would not be allowed for “elective” abortions.

The Alaska Supreme Court has held that the state must fund medically necessary abortions if it funds other procedures deemed medically necessary for people in need. However, a legislative legal opinion requested by Sen. Hollis French last year said it’s not clear what makes an abortion medically necessary, and that it’s likely only further litigation would provide greater clarity.

The opinion stemmed from proposed state regulations of abortion payments. The department had proposed that for an abortion provider to be eligible for payment under Medicaid, the invoice must come with a certificate saying the procedure was medically necessary because the health of the woman was endangered by the pregnancy. Commissioner Bill Streur said his department did not intend to restrict the definition of a medically necessary abortion — a concern that had been raised. The regulations ultimately adopted did not further define the term.

Coghill, R-North Pole, has long been outspoken in his anti-abortion views. But he said his bill, SB49, also speaks to concerns about what is expected to be an increasingly tight state budget. He said the court left legislators to decide what is medically necessary.

“As a right to life guy, I’m interested in that because not only is it a state budget issue, but it really now becomes an issue of when do you actually force somebody from the public to pay for somebody else’s abortion if it’s truly elective,” he said. “I think that question is a serious question, and it should be asked.”

Coghill is part of the new Republican majority that took control of the Senate after November’s legislative elections. He is chairman of the Senate Judiciary Committee, which would hear the bill first. SB49 had at least six co-sponsors as of early Monday afternoon, including Sen. Donny Olson, D-Nome. Olson is a member of the majority caucus.

Information provided by the department shows during the last fiscal year, the state paid for 539 abortions, at a cost of about $191,000. In fiscal year 2011, it paid for 691 abortions, at a cost of nearly $245,000. In 2010, the state paid for 831 abortions, at a cost of about $290,000.

Medically necessary, as defined by the bill, states that it is a doctor’s “objective and reasonable professional judgment” that an abortion must be performed to avoid threat of serious risk to the life or physical health of the woman. That could mean a serious risk of death or “impairment of a major bodily function” due to such things as renal disease that requires dialysis; congestive heart failure; coma; or “another debilitating physical condition.”

French, D-Anchorage, called the proposal a “radical departure” from existing law.

“I think the chief danger is that you’re interrupting what is now an extremely private matter between a woman and her doctor, sorting out an extremely difficult issue,” he said.

Treasure Mackley, political and organizing director at Planned Parenthood Votes Northwest, called the proposal “dangerous for Alaskan women.”

“In a state where we have some of the highest rates of rape and incest, Coghill would force women in the most vulnerable circumstances to navigate the legal system in order to obtain the medical care they need,” Mackley said in a statement. “With the rate that assaults go unreported in our often small, tight-knit communities, this bill puts a foreboding burden on Alaskan women.”